An Alternative Approach to Adult One-Lung Ventilation Using a Standard Single-Lumen Endotracheal Tube

Endobronchial intubation with a double-lumen tube (DLT) is a frequently used method for achieving one-lung ventilation (OLV) in adults, together with simultaneous contralateral lung deflation during intrathoracic surgical procedures. Alternative methods of providing OLV include the bronchial blocker (BB), which comes in several different models (Univent {Columbia, MD: Ambu Inc.}, Arndt blocker {Bloomington, IN: Cook Medical}, Cohen Flex-Tip blocker {Bloomington, IN: Cook Medical}, EZ-Blocker {Morrisville, NC: Teleflex Incorporated}). This case report presents another cost-effective alternative approach to OLV utilizing resources readily found in an operating room setting. This alternative approach to OLV via elective endobronchial intubation of a mainstem bronchus utilizing a standard single-lumen endotracheal tube (ETT) can be especially handy when difficult DLT or BB placements are encountered (difficult airways/severely limited mouth opening/rigid bronchoscopy procedures), in emergent situations involving a unilateral lung (massive bleeding/infection/bronchopleural fistula/pneumothorax), in remote locations out of the operating room or when there are limited resources. It can also be a potential pragmatic way to administer OLV when a patient scheduled for an intrathoracic surgical procedure comes to the operating room already intubated with a single-lumen ETT and will return intubated.